| NPI | 1124793666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY34309) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY34309) |
| 103TH0004X Psychologist Health (Licence: CA PSY34309) | |
| 103TH0004X Psychologist Health (Licence: AR 202119) | |
| 103G00000X Clinical Neuropsychologist (Licence: AR 202119) | |
| 103TC0700X Psychologist Clinical (Licence: AR 202119) | |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2023-11-27 |